HYPERTHYROIDISM IN PREGNANCY

A Case Study presented to the faculty

of THE COLLEGE OF HEALTH

Lyceum of Aparri

Aparri, Cagayan

In Partial Fulfillment of the Requirements

of the Related Learning Experiences

for the Second Term of

A.Y. 2023-2024

Study By

Pagarigan, Lysette Porillo

Palapuz, Steven Kyle Alameda
Purisima, Precious Gabriel
Quequegan, Lovely May Urtis
Recolizado, Provie Anne Abadicio
Umangay, Lyka Mae Calaguian

BSN-I-H

APRIL 2024
 HYPERTHYROIDISM IN PREGNANCY

ACKNOLWEDGEMENT
(insert)

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 HYPERTHYROIDISM IN PREGNANCY

TABLE OF CONTENTS
Acknolwedgement.....................................................................................................................ii
Table of Contents......................................................................................................................iii
Objectives...................................................................................................................................1
General Objectives.............................................................................................................1
Specific Objectives:...........................................................................................................1
Introduction................................................................................................................................2
Precis......................................................................................................................................2
Etiology..................................................................................................................................4
Risk Factors............................................................................................................................5
Clinical manifestations...........................................................................................................6
Assessment and diagnostics...................................................................................................7
Medical Management.............................................................................................................8
Prognosis................................................................................................................................8
Complications.........................................................................................................................9
Epidemiology.......................................................................................................................10
Assessment...............................................................................................................................11
Patient’s profile....................................................................................................................11
Health History......................................................................................................................12
Present Health History.....................................................................................................12
Past Health History..........................................................................................................13
Gynecological History.....................................................................................................13
Obstetric History..............................................................................................................13
Social Health History.......................................................................................................13
Gordon’s Functional Pattern.................................................................................................14

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 OBJECTIVES

General Objectives

The Study aims to identify suitable nursing care approaches for pregnant women with
hyperthyroidism, considering various statuses and backgrounds.

Specific Objectives:

Knowledge

To define Hyperthyroidism, its etiology, types, and management.

To identify the complications which Hyperthyroidism may contribute to pregnancy
To be able to understand Maternal Health

Skill

To effectively assess patients with goiter and other visible masses

To effectively assess and manage clients in labor
To be able to deliver post-partum care to Clients

Attitude

To establish a rapport
To be able to provide care with grace under pressure
To acknowledge the diversity of individuals in need of nursing care
To be able to render quality nursing services with the virtue of respect to every client
despite differences in conditions, status, and beliefs
To have Empathy and compassion towards expecting mothers as a manifestation of
gratitude to all dedicated mothers

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 CHAPTER I
INTRODUCTION

BACKGROUND OF THE STUDY

Hyperthyroidism is among the most common, endocrine-related conditions. It

involves the overproduction of thyroid hormones, responsible for metabolism and
thermoregulation. These Hormones are produced by the thyroid gland. This butterfly-shaped
organ is situated anteriorly in the lower neck and consists of two connected lobes on either
side of the trachea (Physiopedia, 2015)

Hyperthyroidism occurs because of the overstimulation of the Thyroid Gland. Several

factors can lead to the disease, including autoimmune disorders such as Graves' disease,
where the body's immune system mistakenly attacks the thyroid gland, stimulating it to
produce excess hormones.

Figure 1. Judith and her Maidservant (Gentileschi, Florence)

Goiter, a Sign for Hyperthyroidism and other thyroid dysfunction
conditions, is often depicted in Renaissance art to somewhat enlarge the
neck which symbolizes beauty, wealth and prosperity among woman of
high social order.
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 Women are more prone to Hyperthyroidism than men. Hyperthyroidism in pregnancy
affects a small percentage of expectant mothers and is characterized by elevated levels of
thyroid hormones and reduced thyroid-stimulating hormone. During the first trimester of
pregnancy, your baby relies on your thyroid hormone supply for brain and nervous system
development. Pregnancy hormones like hCG and estrogen can elevate thyroid hormone levels
in your blood, while thyroid enlargement is common but usually not noticeable. To expecting
mothers who already have Hyperthyroidism, their term would further complicate their
condition, usually manifested by the thyroid enlarging more.

Figure 2 Rachel giving birth to Joseph (Furini, Italy) Throughout centuries,

Women were regarded as noble as they have become a vessel for procreation

Abnormal Thyroid Function during pregnancy is a concern. Tendencies may fall to

preterm labor, low birth weight, preeclampsia, or worse, miscarriage. Thus, Patients with
Hyperthyroidism should be treated with utmost care during pregnancy; from conception to
birth. It is relevant to uphold the dignity of all mothers despite their conditions, status, and
beliefs. Quality Nursing care must be given to all expecting mothers as most mothers are the
epitome of genuine love and care; an example to whom Nurses should pattern themselves.

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 ETIOLOGY

According to a 2018 study, hyperthyroidism can arise for many different reasons. Some
possible causes of hyperthyroidism include:

The Over Stimulation of the Thyroid Gland

The overstimulation of the thyroid gland, typically caused by conditions like Graves'
disease or nodular goiter, leads to hyperthyroidism due to excessive production of
thyroid hormones. The Immune System produces an antibody called Thyroid
stimulating Hormone antibody which stimulates the Thyroid gland to produce excess
thyroid hormone. Without proper regulation, the thyroid gland continues to produce
hormones in excess, perpetuating the hyperthyroid state.

Decreased production of thyroid hormones

When thyroid hormone synthesis is impaired, as in conditions like Hashimoto's

thyroiditis or thyroid nodules, compensatory mechanisms may be activated to
stimulate the thyroid gland excessively, resulting in hyperthyroidism despite reduced
hormone levels. This compensatory response, often mediated by factors such as
thyroid-stimulating hormone (TSH) receptor autoantibodies in Graves' disease, can
lead to a state of thyroid hormone excess, characterizing hyperthyroidism.
Consequently, despite the underlying decrease in thyroid hormone production, the
resultant hypermetabolic state manifests clinically as hyperthyroidism.

Exposure to certain medications

Some people taking medication to treat hypothyroidism take too much, which raises
their thyroid hormone levels. Anyone taking such medication should have a doctor
check their hormone levels at least once a year. They should also discuss drug
interactions with a doctor before taking any new medications.

Excessive Iodine Intake

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 According to the National Institute of
Diabetes and Digestive and Kidney
Diseases (NIDDK) consuming too much
iodine may cause the thyroid to produce too
much thyroid hormone, leading to
hyperthyroidism. Some heart drugs, cough
medications, and seaweed-based products
may contain a lot of iodine.

Despite the many pathways to hyperthyroidism,

most Thyroid dysfunction conditions lead to the
said disease The most common conditions that
cause hyperthyroidism are:

Grave’s Disease
Graves’ disease is an autoimmune disease.
It arises when the immune system mistakes
Figure 3. Leonardo Da Vinci's “Design of Lady with
Graves’ disease” portrays a woman with eyes
protruding

the body’s cells for foreign invaders and attacks them. Scientists do not know exactly
how the process unfolds in Graves’ disease. However, there are several risk factors
for this condition.

Toxic Nodular Goiter

Toxic nodular goiter arises when small, round masses appear within an enlarged
thyroid. These are nodules. In people with toxic nodular goiter, these nodules produce
too much thyroid hormone.

Thyroiditis

Thyroiditis is the inflammation of the thyroid gland. There are many causes of
thyroiditis, including fibrosis, infections, and intake of certain drugs, including
lithium and interferons, and trauma.

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 RISK FACTORS

According to Jhons Hopkins Medicine, several conditions that can affect diseases hormone
production include Graves excessive consumption of iodine supplements, inflammation of
the thyroid gland after childbirth, and endocrine system disorders. These things may make it
more likely for you to have hyperthyroidism:

Female gender
Age over 60
History of thyroid disorders
Family history of thyroid disorders
Presence of certain comorbidities such as type 1 diabetes
Excessive iodine intake from diet or medication
Recent pregnancy or childbirth within the last six months

CLINICAL MANIFESTATIONS

According to Cleaveland Clinic (2022), Hyperthyroidism causes a variety of symptoms that

can affect the entire body. You may encounter some of the following symptoms:

Rapid heartbeat (palpitations).

Feeling shaky and nervous.
Weight loss
Increased appetite
Diarrhea and more frequent bowel movements.
Vision changes
Thin, warm and moist skin
Menstrual changes.
Intolerance to heat and excessive sweating.
Sleep issues.
Swelling and enlargement of the neck from an enlarged thyroid gland (goiter).
Hair loss and change in hair texture (brittle).
Bulging of the eyes (seen with Graves’ disease).
Muscle weakness

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 Cognitive Deficits such as memory loss, hazy mind et cetera

ASSESSMENT AND DIAGNOSTICS

Hyperthyroidism is diagnosed with a medical history, physical exam and blood tests.
Depending on the results of the blood tests, you may need other tests too.

Medical history and physical exam.

During the exam, your health care provider may check for:

Slight tremor in your fingers and hands.

Overactive reflexes.
Rapid or irregular pulse.
Eye changes.
Warm, moist skin.
Enlarged Thyroid

Your provider also examines your thyroid gland as you swallow to see if it's larger than
usual, bumpy or tender.

Blood tests

Blood tests are crucial in diagnosing hyperthyroidism, measuring levels of T-4, T-3, and
TSH. Elevated T-4 and depressed TSH levels are typical indicators. Older adults, who might
not exhibit typical symptoms, particularly benefit from these tests.

Radioiodine scan and uptake test

Radioactive iodine uptake test involves administering a small dose of radioiodine to assess its
absorption by the thyroid gland. High uptake indicates excessive thyroid hormone
production, possibly due to Graves' disease or overactive nodules. Low uptake suggests
leakage of stored hormones into the bloodstream, indicative of thyroiditis.

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 Figure 4. Ultrasonography of the Thyroid

Thyroid ultrasound

Thyroid ultrasound uses sound waves to create images of the thyroid, often superior for
detecting nodules. It's safe for pregnant, breastfeeding individuals, or those unable to undergo
radioactive tests due to lack of radiation exposure.

MEDICAL MANAGEMENT

According to american thyroid association, The medical management for hyperthyroidism in

pregnant women involves careful monitoring and treatment to ensure the health of both the
mother and the baby. Here are some key aspect:

Medical Management:

1. Antithyroid Medications: Administering antithyroid medications like

Methimazole or propylthiouracil (PTU) as prescribed by the healthcare provider to
control hyperthyroidism.

2. Regular Monitoring: Conducting regular thyroid function tests to adjust

medication dosage and monitor thyroid hormone levels.

3. Fetal Monitoring: Monitoring the baby’s growth and development through regular
ultrasounds to ensure the well-being of the fetus.

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 4. Surgical treatment for hyperthyroidism during pregnancy is usually considered a
last resort when other medical management options, such as antithyroid medications
and radioactive iodine therapy, are not effective or safe for the mother and the baby.
The decision to proceed with surgery during pregnancy is complex and requires
careful consideration of the risks and benefits for both the mother and the fetus.

Nursing Management:

1. Patient Education: Providing education to the patient about hyperthyroidism, its

management, and the importance of adherence to medication and follow-up
appointments.

2. Monitoring Vital Signs: Regularly monitoring vital signs such as blood pressure,
heart rate, and temperature to assess the patient’s condition.

3. Nutritional Support: Collaborating with a dietitian to ensure the patient follows a

well-balanced diet that supports thyroid health and pregnancy.

4. Emotional Support: Offering emotional support and reassurance to the patient as

managing hyperthyroidism during pregnancy can be stressful.

5. Medication Administration: Administering antithyroid medications as prescribed,

monitoring for side effects, and educating the patient on medication compliance.

6. Collaboration with Healthcare Team: Working collaboratively with physicians,

endocrinologists, and other healthcare providers to ensure comprehensive care for the
patient.

7. Alleviate Symptoms related to abnormal Regulation: This includes management

of Hyperthermia, Sweating and other manifestations

PROGNOSIS

Hyperthyroidism is a manageable and treatable condition, and most people do well with
treatment. The expected outcomes of hyperthyroidism treatment include:

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Hypothyroidism: After treatment, it is common to develop hypothyroidism, which is an
underactive thyroid. This is because some treatments, such as radioactive iodine therapy or
surgery, reduce thyroid hormone levels to very low levels or remove the thyroid gland
altogether. Hypothyroidism can be managed by taking replacement thyroid hormone
medication for the rest of your life.

Euthyroidism: Some individuals may achieve a state of euthyroidism, where their thyroid
hormone levels are within the normal range without the need for medication.

Further treatment: In some cases, additional doses of radioactive iodine may be required if
hyperthyroidism persists or recurs.

COMPLICATIONS

Cardiovascular Complications: Hyperthyroidism is associated with increased risk of

cardiovascular disorders such as atrial fibrillation, heart failure, and myocardial infarction
(Klein & Danzi, 2007).

Osteoporosis: Chronic hyperthyroidism can lead to accelerated bone turnover and loss of
bone mineral density, predisposing individuals to osteoporosis and an increased risk of
fractures (Vestergaard, 2002).

Thyroid Storm: In severe cases, untreated hyperthyroidism can precipitate thyroid storm, a
life-threatening condition characterized by extreme hypermetabolism and multiorgan
dysfunction (Akamizu, 2018).

Psychiatric Disorders: Hyperthyroidism may contribute to psychiatric disturbances

including anxiety disorders, depression, and cognitive impairment (Bunevicius & Prange,
2006).

Thyroid Eye Disease: Graves' disease, the most common cause of hyperthyroidism, is
frequently associated with thyroid eye disease, characterized by ocular symptoms such as
proptosis, diplopia, and vision loss (Bartalena & Fatourechi, 2014).

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 Complications to Pregnancy

Catherine Crider in 2023 stated that the potential complications of untreated hyperthyroidism
during pregnancy for the mother include:

preeclampsia
hypertension
placental abruption
heart failure
thyroid storm

Complications that the baby may suffer from may include:

premature birth
thyroid conditions
goiter
low birth weight

Though it’s rare, unmanaged hyperthyroidism during pregnancy can result in a miscarriage or
stillbirth.

EPIDEMIOLOGY

According to a Philippine survey in 2012, 8.53% Of the population suffer from

thyroid dysfunction, predominantly subclinical hyperthyroidism at 5.33%. After a series of
mass physical examinations, 8.9% Of the Filipino population suffer from goiter female
Filipino individuals are more prone to hyperthyroidism than the Filipino male, with a ratio of
23;7

6.8% of senior citizens over 65 in a southern Taiwanese survey reported having

thyroid problems. Another study on thyroid disease and dysfunction in adults in Norway
found that 2.5% of females and 0.6% of men had previously been diagnosed with
hyperthyroidism, whereas the frequency of hypothyroidism was the same.

Hyperthyroidism is an uncommon condition that complicates approximately 0.1% to

0.4% of pregnancies. The condition is marked by increased levels of circulating thyroid

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hormones, T4 and T3, as well as a decreased level of thyroid-stimulating hormone (TSH),
also known as thyrotropin.

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 CHAPTER II
ASSESSMENT

PATIENT’S PROFILE
Basic Information
Name Patient O.I.R
Address Zone 4, Catotoran Norte, Camalaniugan, Cagayan
Gender Female
Age 34 years old
Birthday November 08, 1989
Place of Birth Catotoran Norte, Camalaniugan, Cagayan
Nationality Filipino
Civil Status Married
Duration of Marriage 10 Years
Occupation Housewife
Religion al-Islām
OB-Gyne Data
GP Score G7P7 (7007)
LMP July 09, 2023
EDC April 14, 2024
AOG 39 6/7
Admission Data
Date and Time April 13, 2024, at 06:00 pm Type of Admission Old
Chief Complaint Labor Pain
Admitting Diagnosis G7P6(6OO6) Preuterine 39 6/7; Hyperthyroidism
G7P7 (7OO7) Delivered Via Normal Spontaneous Delivery; Apgar Score = 8,9; Ballard
Final Diagnosis
score: 38; Birthweight 2.44 kg; Birth Length 44cm; Low Birth Weight; Female
Admitting Physician Dr. J.K.R Attending Physician Dr. T.S
Hospital Aparri Provincial Hospital Ward OB-Gyne Ward
Admitting Vital Signs
Blood Pressure 120/80 mm/Hg Temperature 36.6 °C
Cardiac Rate 89 BPM Weight 46 kg
Respiratory Rate 21 CPM Height 165 cm
Oxygen Saturation 99% Body Mass Index 16.9 kg/m2
Source of Information The patient herself and her Chart Date and Time Interview April 15, 2024; 1:00 pm

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 HEALTH HISTORY

Present Health History

Three days prior to admission, Patient OIR felt pain in her lower back. On the morning of
April 13, 2024, (INSERRRRRRRRRRRT MORNINENNNNNNGGGG) Patient felt
contractions around 3:00 PM while she was taking care of her six children. She initiated
ambulation to accelerate the labor process. She admitted herself, accompanied by her
husband at 6:00 PM at the Aparri Provincial Hospital.

According to the patient, she was advised to be brought and managed at the Cagayan Valley
Medical Center due to her present health condition of hyperthyroidism which is considered to
be a high-risk case yet current manifestations and verbal cues prompt immediate management
because the child may be delivered the soonest. This is according to the patient’s
verbalization.

The height of the fundus was 31 cm, which is different from the normal fundic height for
gestating mothers at 39 weeks which is 37 to 41 cm. Upon labor management, the Patient’s
cervix was fully dilated at 10 cm with 5 contractions every 10 minutes. The bag of water was
still intact and the baby was in cephalic presentation based on admitting physical
examination. Fetal heart rate was at 134 bpm and the mother’s cardiac rate was 85 bpm. The
mother’s blood pressure is surprisingly low at 100/60 mm/Hg.

The patient underwent normal spontaneous delivery. Mother had ease in giving birth,
delivering the baby at 6:20 PM. The placenta was delivered 5 minutes later. The mother
stated that she had ease at giving birth because she had already given birth to six children.
Upon skin-to-skin contact, the mother felt a sense of relief stating that she is overjoyed with
the birth of her seventh child. Oxytocin was injected post-partum intramuscularly. Perineal
support was then rendered.

During hospitalization, the mother surprisingly performed her tasks as a parent stating that
nobody else could do these responsibilities rather than her. During her first day at the
hospital, her vital signs were stable. Yet at the dawn of April 14, 2024, the patient’s blood

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pressure dropped to 100/60 mm/Hg, and approaching evening, the patient’s blood pressure
dropped to 90/60. Patient did not report of bleeding after labor.

Past Health History

According to the patient, she completed the necessary immunizations needed for infants yet
failed to recall these vaccinations. The patient verbalized that she suffered from
hyperthyroidism since she was 12 years of age. She stated that she regularly had checkups in
her adolescence age yet failed to often have one upon entering adulthood due to an
unspecified reason. She used to take medications to treat it yet due to financial reasons, the
patient halted her medications. The patient failed to recall these medications. Patient OIR also
noted that during every pregnancy she had, her goiter enlarged.

The patient stated that she has a history of UTI and gastritis. She also noted that she has skin
allergies to laundry products specifically to bleach. The patient is fully vaccinated against
COVID-19 with AstraZeneca as her vaccine.

Gynecological History

The patient’s menarche occurred when she was 12 years of age. She has a regular menstrual
cycle which usually lasts for seven days. Throughout her life, the patient hasn’t encountered
any gynecological problems although the patient stated that she excessively bleeds during
menstruation.

Obstetric History

The patient has seven children: three boys and four girls. In her first pregnancy, she was
induced at 39 weeks. The baby weighed 2.5kg at birth. She gave birth at Matilde Hospital in
2015. Her second pregnancy 1 year later underwent normal spontaneous delivery at
Mindanao. She gave birth to her third, fourth, fifth, and sixth children in the Aparri Provincial
Hospital. The Patient stated that she had ease giving birth to all of her children, describing her
experience as sanay na.

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 Family Health History

Figure 5. Family Genorgram of Patient OIR

The above image is a genogram of Patient OIR, depicting their family structure and health
history. Genograms provide a visual representation of familial relationships and illnesses,
aiding healthcare professionals in understanding inherited health patterns. This genogram
assists in contextualizing Patient OIR's health.

Figure 6. Legend for Genogram

Social Health history

Patient OIR is an only child. She used to drink liquor with his friends during her free time
and if there is an occasion. When she reached 20, she started earning money by selling thrift
clothing and vegetables in the market. She graduated from high school and did not pursue her
study in college. She always goes to worship with her family as bonding. She had an intimate
and committed relationship with his husband although had a history of disappointment when
her husband housed a second wife. She is a very dedicated housewife, taking care of her
children unconditionally.

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 GORDON’S FUNCTIONAL PATTERN

Gordon's functional health patterns framework serves as a structured assessment tool

extensively utilized in nursing practice. With its 11 categories encompassing various
dimensions of health, it offers a comprehensive approach to evaluating an individual's well-
being. Through this framework, nurses conduct systematic assessments across these patterns,
enabling a holistic understanding of the patient's health status. By identifying strengths,
weaknesses, and potential health risks, nurses can formulate personalized care plans tailored
to address the unique needs of each individual effectively.

Health Perception/Health Management

Before Hospitalization During Hospitalization Analysis

“(Do you consider your

self healthy?) Hindi kasi
may goiter ako pero may
time din na sakitin ako
more on UTI ako at yung
Gastritis kasi mahilig ako
sa maasim at coke” As
verbalized by the patient
Pertaining to her Hygiene,
“Nakakaligo naman ako
tatlong beses isang araw.
Importante ang hygiene ko.
Pero minsan, dahil busy
mom tayo, nakakalimutan
na natin ang ating mga
sarili”
Patient Stated “…pero
noong pinagbubuntis ko po
tong anak ko ngayon, laig
po akong maingat pero go
parin po sa mga usual na
Gawain ko po” when asked
about her health perception
during pregnancy.
The patient bases her perception of
health on her chronic condition, some
casual illnesses such as UTI and
Gastritis, and diet. Her present illness
of Hyperthyroidism makes her feel
“Hindi parin kasi as long inferior as a wholesome individual yet
as meron parin akong Patient OIR honestly concludes that
goiter unhealthy ako. she has an unhealthy diet contributing
Matigas ulo ko Ma’am. to her negative perception of health.
Kumakain parin ako ng About her hygiene, she honestly stated
mga pagkain na bawal na that she had trouble maintaining her
di naman maiiwasan” as daily hygiene routine due to her duties
verbalized by the patient as a mother. During hospitalization,
visual inspection suggests that the
patient struggled to maintain proper
hygiene as manifested by ungroomed
hair and visible grime in skin.

Nutritional/Metabolic
Before Hospitalization During Hospitalization Analysis

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“Malakas ako kumain ng
kanin kahit anong ulam,
As a devout Muslim, Patient OIR do
more on sabaw, de lata…
not consume Pig as outlined in the
mahilig din ako sa kamote
Islamic law, Halal.
at nilagang saging… Di
Due to economic reason, Patients
ako kumakain ng pork kasi
“Kung ano yung consume whatever is present in their
alam niyo na po sa
binibigay nila… garden and often buy canned goods.
muslim… and nagmimilk
nagmimidnight snack Although the patient admittedly state
din ako pero more on gulay
din po ako ” As that she consumes a lot to the extent
talaga ako kung ano yung
verbalized by the patient that she ate midnight snack even
makikita sa hardin, yun na.
during hospitalization.
Pero kahit marami akong
Diet ordered: NPO She also rarely eats seafood which is
rice na nakakain, di parin
(during labor), Diet as rich in Iodine. Iodine is essential in
ako tumataba ng grabe” As
Tolerated (Post-Partum) Thyroid hormone production. Though
verbalized by the patient
Average Number of when taken in less amounts may lead
Daily Meals: 6 to hypothyroidism or low thyroid
“(Kumakain po ba kayo ng
Typical Meals taken: hormone production, this would let
isda, seafood?) Madalang
Did not specify TSH to stimulate the Thyroid to
lang po”
Average daily Fluid increase thyroid hormone production
intake: which may lead to an unregulated
Patient OIR also states that
2 Liters production of thyroid hormone.
during her pregnancy period,
she consumed large amounts
The Patient does not also manifest a
of food even stating she ate
IV Fluid: D5LRS 1L for bulk or round body shape despite of
midnight snacks such as
10 Hours at 124mL/Hour her large intake of rice and midnight
chocolate bars.
snacking due to the effect of excessive
thyroid production on metabolism.
Average Number of Daily
Meals: 6
During Hospitalization, she consumes
Typical Food choices:
whatever the Hospital gave her still
Garden grown Vegetables,
with casual snacking at night.
Rice, Broths
Average daily Fluid
Patient consumes a lot of fluids before
intake:
and during hospitalization.
2 Liters

Before Hospitalization
“Minsan 4 or 5x a day ang
pagihi ko po this past few
months… Pawisin rin po
ako…” As verbalized by the
patient
The Patient also gleefully
Elimination
During Hospitalization Analysis
“Hindi ako masyadong The patient excessively sweats as a
maka ihi kasi manifestation of abnormal
nahihirapan akong thermoregulation brought to by the
umuwi. After 1 day na excessive production of thyroid
po ako nung nakatae hormones. During her pregnancy, the
ako” As verbalized by the patient frequently urinates.
patient

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state, “Basta nagbubuntis
rin po ako, nahihirapan po
akong tumae. Mahirap
ilabas”
Average daily Urine
Ouput: 5 times (during
pregnancy)
Average daily Defecation:
Thrice a day
Before Hospitalization
Patient Stated, “Ang
pinakaexcercise ko Ma’am
ay yung pagtrabaho ko po
sa bahay; magigib,
maglaba, maggardening…
Minsan agpagnapagna na
met nukwa”
Before Hospitalization
Patient stated, “Mabilis po
ako makalimot”,
Patient also stated she has
blurry vision. She expressed:
“Medyo malabo po talaga
pagtingin ko.”
Patient also expressed the
will to have her eyes
checked and acquire
prescription glasses.
“Kaylangan ko po sana
ipacheck Sir kasi
Concerning defecation, the patient has
frequent bowel movements before
hospitalization due to the thyroid
According to the Patient’s
hormone effect on the nerves in the
Chart, Her diaper was
digestive tract. It is normal to have no
changed once on the day
defecation after giving birth due to the
of her admission and
physiological stress of the abdominal
urinated only once a day
muscles which induce defecation.
after labor.
Frequent urination before pregnancy is
Average daily Urine
normal as the fetus grows and
Ouput: 1
develops, it gives pressure to the
Average daily
urinary bladder. Due to physiologic
Defecation: 1
stress during childbirth, this resulted to
difficulty of urination.
Activity/Exercise
During Hospitalization Analysis
Patient Stated: “After As a dedicated housewife, the patient
kong nanganak ma’am considers household chores as her
gumalaw galaw na po activity and exercise. The role of a
ako! Nag-iigib na po ako mother is demanding thus finding time
ng tubig kahit medyo for the typical exercise like jogging,
mahirap pa po, medyo lifting et cetera can be alternatively
mag bigat at sakit sa may substituted through house tasks. As
paa ko po”; stated in the patient’s history, giving
“(Bakit) Pagpaligo ko po birth has become an ease for the
kay Baby. Wala naman mother thus even after giving birth, she
pong ibang gagawa nun still fulfilled her responsibility as a
kung di lang po ako” mother.
Cognitive/Perceptual
During Hospitalization Analysis
“Ganun pa din ma’am Due to inflammation and damage to
wala parin namang the tissues around the eye, including
nagbago ma’am” As muscles, fatty tissue, and connective
verbalized by the patient tissue caused by Hyperthyroidism,
ophthalmic pressure is evident causing
the patient to have blurry vision.
Hyperthyroidism also causes cognitive
deficits which include memory loss.
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nahihirapan po talaga ako
makakita lalo may mga
alaga po akong bata”
Sleep/Rest
Before Hospitalization During Hospitalization Analysis
“Literal na di po ako
nakakatulog. May 24
“Hindi maganda ang
hours na po akong
quality ng sleep ko sir. Late
gising” As verbalized by
ako natutulog sir.
the patient
Kaylangan ko rin magising
ng maago po para sa
In another Statement,
pagpasok ng mga bata sa
“Ako po kasi nagtitimpla
school… Kapag
ng gatas ni baby tapos Since the patient is oriented around her
nagpapatulog po ako ng
ayaw niyang magpababa responsibility as a mother, sleep is
bata sa hapon, nakakatulog
kaya ito po, binubuhat ko considered less of a priority for her to
rin naman po ako pero mga
lang po siya ma’am” fulfill her role.
isang oras lang po” As
verbalized by the patient
The Patient stated she took
a Sleep at 11:00 PM last
Duration of Sleep: 6 Hours
April 13, 2023 and woke
Bedtime: Around 11:00 PM
up the same at 5:00 AM of
Wake Time: Around 5:00
April 14, 2024. Recalled a
PM
2-hour nap last April 14,
2024 and an unspecified
Self-Perception/Self-Concept
Before Hospitalization During Hospitalization
Analysis

Patient Stated, “Nafufullfill
ko din ang aking
responsibility bilang isang
ina ginagawa ko lahat ng
makakaya ko para sa mga
anak ko inaalagaan ko sila
ng maayos kahit hindi ko
na maayos ang sarili ko
basta maalagaan ko lang
ang mga anak ko”
Patient also stated, “May
time na nadepress po ako
lalo noong time na
nagkaroon ng second wife
ang aking asawa. I took it
negatively po, nag-nigarilyo
“Nakikita ko palang anak The patient is a proud mother. She
ko, nasisiyahan na po clearly sees herself fulfilling the task of
ako” as verbalized by motherhood. She defines herself as a
patient mother.
The patient had a negative self-
deprecating behavior towards his
husband's second marriage. She
undermined her well-being through
smoking. Yet with this incident, she
chose to accept it in accordance with
their belief.

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po ako noon dahil doon.
Pero kinailangan ko pong
tangapin dahil iyon po ang
sinasabi ng aming
paniniwala”
Pertaining to her pregnancy,
“Grabe po moodswings ko
po noon.”
Before Hospitalization
Patient stated, “Ok naman
na po ako sa asawa ko
ngayon. Pero ang
pinakabuhay ko talaga ay
mga anak ko.”, “wala
naman akong nakakaaway
kasi Maganda naman yung
pakikitungo ko sa mga
tao”, “Naging active rin po
ako sa Community
(Muslim) po naming; for
guidance po ganun,
lumalapit po ako sa kanila”
Before Hospitalization
“Basta kaya po ng asawa
ko po, payag naman po
ako” patient stated
pertaining to Procreation.
Patient also stated that they
do not follow Family
Planning and contraceptives.
Role/Relationship
During Hospitalization Analysis
The patient describes that she is well
“Meron din bumibisita sa
with her husband yet her statement
akin ma’am, yung mga
centralizes on the fact that what
kasama naming sa
matters most to her is her relationship
community” As
with her children, even making them
verbalized by the patient
the main reason for life. She also
considers the Muslim Community as
As the interview
relevant individuals in her life.
progressed, The Patient’s
Husband arrived, then
Regarding her relationship with her
asked the patient about the
husband, the incident that occurred
nature of the assessment in
during interview indicates that wife
a slightly aggressive tone
may fear his husband. The Patient’s
to which the Patient
lying may suggest that the true
responded with a lie even
objective of the assessment may upset
though she was informed
her husband thus she deviated from the
of the purpose of the
truth to spare the student nurses from
assessment.
how would her husband react.
Sexuality/Reproductive
During Hospitalization Analysis
Islam generally supports family
planning as long as it aligns with the
well-being of the family and society.
Contraceptives are permitted for
spacing births or limiting family size,
Patient refused to undergo but permanent sterilization methods are
Bilateral Tubal Ligation discouraged. Procreation is considered
a sacred duty in Islam, but it should be
balanced with responsible parenthood
and consideration for the health and
welfare of existing children and the
family unit.
Coping/Stress Tolerance
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 Before Hospitalization
“Makipag kwentuhan,
tsismis sa mga kapit bahay,
magluto, kumain di kasi
ako mahilig mag
cellphone” As verbalized by
the patient in a gleeful
manner
Before Hospitalization
“Muslim po ako since
birth. Yung pagsamba at
dapat kailangang sumunod
sa mga patakaran. Huwag
gawin yung mga
ipinagbabawal nila ganun.
Binabasa ko rin po yung
Qur'an” As verbalized by
the patient
Patient also stated, “There
are times na I question
Him, pero di po Nawala
ang aking paniniwala”
During Hospitalization Analysis
“Yung anak ko sa kanila
The patient adopted the Filipino
na lang ako nagfofocus
culture of gossiping to which she
sila yung nagpapawala
admits merrily. Yet again as a mother,
ng pagod ganun.
she sees her children as her comfort
Pinipisilpisil ko pa siya
against stress even treating her
minsan” As verbalized by
newborn as a fidget.
the patient
Values/Beliefs
During Hospitalization Analysis
In Islamic Belief, all people are born
Islam yet a child is usually marked as a
Muslim when the adhan (a call to
prayer) is whispered into the Child’s
ear and given a Muslim name. The
patient strictly follows what Islam
“Di po ako masyadong instructs. She is a devout Muslim who
nakapagsamba dito sa prays and reads the Qur'an, the sacred
ospital” as verbalized by text of Islam.
patient.
However, at some period of her life felt
the need to question Allah, especially
at times of trial such as when her
husband housed his second wife. Yet
this has not become a hindrance to her
belief in Allah.
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 PHYSICAL ASSESSMENT

General Survey:

The Patient was assessed physically on the Fifteenth of April, 2024 at 3:00 PM. The Patient is
an ectomorph. Her hair was not well groomed and visible grime is observe in localize areas in
patient’s arm and clothing.
Vital Signs:

BP= 110/90 mmHg PR= 74 bpm O2Sat= 97% Temp= 36.8°C RR= 23 cycles

NORMAL ACTUAL
AREA ASSESSED METHODS ANALYSIS
FINDINGS FINDINGS
SKIN
GENERAL SKIN INSPECTION  Evenly  Evenly Normal
COLORATION colored colored
skin tones skin tones
without without
unusual unusual or
or prominent
prominent discolorati
discolorat on
ion
Skin integrity and INSPECTION  skin is  (+) rashes d/t irritation
texture and intact, on both to fabric bleach and
PALPATION and there feet the rapid growth of
are no number of skin cells
reddened associated with
areas hyperthyrodism
 skin is  (+) rash on  heat rash d/t
smooth patient’s excessive
and even posterior sweating which
thorax dries up skin

THICKNESS PALPATION  skin is  (+) d/t strenous

normally calluses at household activities
thin but digitals such as laundry
calluses
(rough,
thick
sections
of
epidermis
) are
common
on areas
of the
body that
are
exposed

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 NORMAL ACTUAL
AREA ASSESSED METHODS ANALYSIS
FINDINGS FINDINGS
to
constant
pressure
MOISTURE PALPATION  skin  isolated  heat rash d/t
surface dry areas excessive
vary from at patients sweating which
moist to arms , feet dries up skin
dry and back,
dependin heat rash
g on the
area
assessed
TEMPERATURE PALPATION  skin is  skin is d/t increase body
normally warmer to metabolic process
warm in touch at related to thyroid
temperatu face and production
re palm
DETECT EDEMA PALPATION  skin  skin NORMAL
rebounds rebounds
and does and does
not not remain
remain indented
indented when
when pressure is
pressure released
is
released
SCALP AND HAIR
GENERAL INSPECTION/  natural  hair is d/t poor hygiene and
COLOR AND PALPATION hair color, ebony in hormonal effects
CONDITION OF as color, thin, such as thyroid
SCALP AND opposed and dry hormones which alter
HAIR to the production of hair
chemicall cells
y colored
hair
 scalp is
clean and
dry.
 hair is
smooth
and firm,
somewhat
elastic
NAILS
GROOMING AND INSPECTION  Nails are  Nails are Normal
CLEANLINESS, clean and clean and
COLOR manicure manicured
d  Pink tones
 Pink should be
tones seen
should be  Nails are
seen hard and

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 NORMAL ACTUAL
AREA ASSESSED METHODS ANALYSIS
FINDINGS FINDINGS
 Nails are basically
hard and immobile
basically 
immobile

BLANCH TEST  Pink tone  Pink tone Normal
returns returns
immediat immediatel
ely to y to
blanched blanched
nail beds nail beds
when when
pressure pressure is
is released.
released Within
0.35
seconds
HEAD AND FACE
HEAD INSPECTION  head size  head d/t thyroid growth
and shape slightly
vary, tilts to the
especially right
in accord
with
ethnicity
 symmetri
c, round,
erect and
in midline
 No
lesions
MOVEMENT INSPECTION  head  The patient d/t thyroid growth
should be had
held still difficulty
and in rotating
upright and flexing
head
HEAD PALPATION  head is  head is Normal
normally normally
hard and hard and
smooth, smooth,
without without
lesions lesions
FACE INSPECTION  face is  face is Normal
symmetri symmetric
c with a with a
round, round,
oval, oval,
elongated, elongated,
or square or square
appearanc appearance
e  no
 no abnormal

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 NORMAL ACTUAL
AREA ASSESSED METHODS ANALYSIS
FINDINGS FINDINGS
abnormal movement
movemen
t
NECK
NECK INSPECTION  neck is  neck has d/t thyroid growth
APPEARANCE symmetri globular
c, with mass
head growth at
centered the left
and part neck
without
bulging
masses
MOVEMENT OF INSPECTION  The  neck d/t thyroid growth
THE NECK thyroid movement
STRUCTURE cartilage is minimal
and
cricoid
cartilage
move
upward
symmetri
cally as
the client
swallows
THYROID PALPATION/  landmark  Obviously d/t thyroid
GLAND AUSCULTATI are enlarged overstimulation,
ON positione  Bruits bruits indicate
d midline were heard presence of blood
 no bruits when vessels
are auscultated
auscultate
d
EYES
Eye Appearance INSPECTION  Eyes Slight bulging D/t ophthalmic
appear of eyes pressure
symmetri
cal and
normal
Eyelid Appearance INSPECTION Eyelids appear  Eyelids Dry and tired eyelids
smooth and appear dry noted due to fatigue
hydrated and tired, and sleeplessness
darker in
color
VISION ASSESSMENT  Normal  Patient D/t ophthalmic
peripheral steted her pressure
vision vision is
blurry
EARS
EARS (General) PALPATION  Skin is  Skin is Normal
and Smooth, Smooth,
ASSESSMENT with no with no
lesions, lesions,

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 NORMAL ACTUAL
AREA ASSESSED METHODS ANALYSIS
FINDINGS FINDINGS
lumps, or lumps or
nodules nodules
 Vibration  Vibrations
s are are heard
heard equally
equally well both
well both ears
ears
LIP AND MOUTH
LIPS INSPECTION/  Lips  Dry lips d/t physiological
PALPATION are distress brought to by
smoo post-partum events,
th excessive heat, and
and abnormal metabolism
moist brought to by
witho hyperthyroidism
ut
lesio
ns or
swell
ing
Gum Color Visual  Pink or  Gums Dark toned gums
inspection coral- appear were observed,
colored black or consistent with
gums darkened smoking history
TEETH
Number of teeth Inspection  32 adult  2 third d/t tooth cavity.
teeth molars are
already
removed
Color and Texture Inspection/  Smooth,  Yellowish Normal
Palpation white, in color
shinny
tooth
enamel
NOSE
NOSE INSPECTION  Color is  Color is Normal
the same the same
as the rest as the rest
of the of the face
face  Able to
 Able to sniff
sniff through
through each
each nostril
nostril  No Nasal
 No Nasal Flaring
Flaring
THORAX INSPECTION,  Symmetri  Symmetric Normal
PALPATION, c  No Masses
ASCULTATIO  No adventitiou
N Masses s sounds,
such as

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 NORMAL ACTUAL
AREA ASSESSED METHODS ANALYSIS
FINDINGS FINDINGS
 No crackles or
adventitio wheezes
us
sounds,
such as
crackles
or
wheezes
FEMALE BREAST
SIZES INSPECTION  Breast  Breast is of NORMAL
can be a normal
variety of size and
size and round in
are shape
somewhat
round
 It may
normally
large than
others
COLOR and INSPECTION  Color  Breast skin NORMAL
TEXTURE varies color is the
dependin same with
g on the the
clients patient’s
skin normal
tones. skin color
 Texture is
smooth
with no
edema
 Linear
stretch
marks
may be
seen
during
and after
pregnanc
y
AREOLAS  Areolas  Areolas NORMAL
vary from are dark in
dark pink color,
to dark compleme
brown, ntary to
dependin patient’s
g on skin color
clients
skin tones
NIPPLES  Nipples  Nipples Maternal Adaptation;
are nearly are Blood flow is
equal engorged increased which
bilaterally initiates milk

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 NORMAL ACTUAL
AREA ASSESSED METHODS ANALYSIS
FINDINGS FINDINGS
in size production. Milk
and are in Accumulation often
same occurs.
location
on each
breast
 Nipples
are
usually
everted,
but they
may be
inverted
or flat
ABDOMEN INSPECTION/  Unblemis  Abdomen Sagging abdomen
PALPATION hed skin appears and stretch marks are
 Symmetri saggy with common postpartum
c noticeable changes due to
 No visible stretch stretching of the
vascular marks abdominal wall and
patterns skin during
 Abdomen pregnancy
is
nontender
and soft
 No
guarding
MUSCULOSKELE INSPECTION  Posture is  Difficulty  Postpartum
TAL erect and walking difficulty
comfortab post-birth walking
le for age observed suggests
 Snapping  Patient potential
and shows issues like
clicking signs of muscle
may be tremor weakness or
felt and while residual
heard in speaking effects from
normal childbirth
client trauma
 Equal size  Tremors
on both occur due to
size of the hypermetab
body olism
 Smooth
coordinat
ed
movemen
t
NEUROLOGIC INSPECTION  Display  Display no  Hyperthyroi
no difficulty dism causes
difficulty speaking the
speaking and can reduction of
and can follow grey matter

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 NORMAL ACTUAL
AREA ASSESSED METHODS ANALYSIS
FINDINGS FINDINGS
follow verbal or in the brain
verbal or written
written instruction
instructio s.
ns.  Patient
 Intact failed to
immediat recall most
e recall, informatio
recent n
memory, regarding
and her
remote condition
memory
 Able to
concentra
tion
GENITAL  
TEXTURE, INSPECTION  Smooth  Smooth NORMAL
COLOR AND  Slightly  Slightly
SHAPE darkened darkened
 Well-  Well-heald
heald episiotomy
episiotom scars is
y scars is normal
normal after
after vaginal
vaginal delivery
delivery

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 COURSE IN WARD

Time/ Side-
Doctor’s Order Rationale Nursing Responsibilities*
Notes
April 13, 2024
 Confirm the Patient’s Identity
Please admit to  To Further monitor and
6:00 PM  Establish Rapport
OB-Gyne Ward manage client
 Assist Patient to Ward
 To establish Legal
Foundation by protecting
Please Secure  Serve as witness
Patient’s Rights and deviating
Consent for  Inform Patient of their rights
the institution from legal
Admission and  Explain the purpose of the
repercussions.
Management Consent
 For Documentation and
Record keeping
TPR
(Temperature,  Take the Patient’s Temperature,
Pulse, and  To establish Baseline Data Pulse, and Respiration as
Respiration) every ordered
shift and record
 To Monitor Patient’s status
 Take and Monitor Patient’s
Monitor VS q4° and progress
Vital Signs every 4 hours as
and Record  To Note for Physiologic
ordered
distress
 Inform Patient and their S.O to
Monitor Input and  To Monitor the Patient’s fluid report accurate frequency and
Output q Shift and and electrolyte balance characteristics of client’s fluid
Record (Kozier et al, 2021) intake and output
 Record IandO as ordered
 To avoid some complications
during labor such as
NPO (Nil Per  Inform and Educate the Patient
pulmonary aspiration
Orem, Nothing by to take nothing by mouth
pneumonitis (American
Mouth)  Keep Patient’s
Society of Anesthesiologists,
2022)
Diagnostics
 To determine whether the
level of Blood Component is  Confirm the Patient’s Identity
within the normal range. This  Explain the Procedure to the
would also check for diseases Patient
and infections that can affect  Secure Consent
CBC with PC and
the health of a pregnant  Assist the Patient in the
Blood Typing
woman and her unborn baby procedure if necessary and
(Medline Plus, 2022). The permitted
results can guide treatments,  Facilitate Lab Request
which may help prevent  Refer Relevant Findings
serious complications
Urinalysis  Identifies the presence of  Confirm the Patient’s Identity
abnormal constituents, such

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Time/ Side-
Doctor’s Order Rationale
Notes
as protein, bilirubin,
urobilinogen, and others in
the patient’s urine (Kozier et
al, 2022)
To determine if the patient has
Hepatitis B surface been infected with the Hepatitis
Antigen Test B Virus; recently or chronically
(HBsAg) (University of Rochester
Medical Center, n.d.)
Rapid Plasma  Detects Antibodies to syphilis
Reagin Test in blood.
CT?  
Therapeutics
 To help ensure that a
pregnant patient maintains
D5LRS 1L for 10
proper hydration levels
Hours at
throughout her entire
124mL/Hour
pregnancy replenish
Electrolyte Fluid loss
Monitor Progress  Monitoring the progress of
of Labor labor is crucial to ensure the
safety and well-being of both
the mother and the baby
during childbirth
Nursing Responsibilities*
 Secure Consent
 Explain the Procedure to the
Patient. Instruct patient on how
to properly collect urine
specimen
 Facilitate Lab Request
 Refer Relevant Findings
 Confirm the Patient’s Identity
 Explain the Procedure to the
Patient
 Secure Consent
 Assist the Patient in the
procedure if necessary and
permitted
 Facilitate Lab Request
 Refer Relevant Findings
 Assess the patient's condition
(medical history, allergies,
fluid balance, and overall
clinical status)
 Document baseline data
 Check for the patency of the IV
line
 Regulate the IV
 Observe for signs of fluid
overload and manifestations
 Monitor and time contractions
during labor and delivery
 Monitor the vital signs of the
mother and the heart rate of the
baby
 Monitor for potentially
dangerous complications;
Identify complications and
notify the doctor
 Communicate with the doctor
to provide timely and accurate
information;
 Encourage the client to void
every 2 hours.
 Provide a comfortable
environment to aid in the
effective coping management
of the client
 Determine Patient’s Pain
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Time/ Side-
Doctor’s Order Rationale Nursing Responsibilities*
Notes
 Encourage ambulation and
changes in position.
 Encourage massage,
acupressure, or
counterpressure to the lower
back
 Explain the procedure to the
mother
 Place Mother in a comfortable
position.
 Undrape patient from the
Monitor Fetal  Used to identify the need for xiphoid process to symphysis
Heart Tone q1° intervention for fetal distress pubis to expose the abdomen;
and Record (Adm_Np, 2017) Still provide Privacy
 Asses Fetal Heart Tone through
auscultation. Note its rate and
characteristic
 Note for abnormal heart tones
and refer
 For continuous monitoring  Refer accordingly and report
Refer
any concerns
Post Partum Management
 Ensure Hygiene when handling
patient
 Loosen the edges of the
dressing and tape in the
direction of the IV site.
 Place a gauze pad over the IV
site and gently pull the IV out
parallel to the skin in a slow
and steady motion.
 Hold pressure on the IV site
Discontinuation of IV fluids for 2-3 minutes.
indicates that the patient has  Inspect the catheter to ensure it
IVF to consume returned to normal body fluid is intact
6:25 PM
then discontinue volume (euvolemia) and can  Ensure proper Disposal of
maintain adequate oral fluid Needles and Catheter
intake (Lassche & Baraki, n.d.)  Remove the gauze pad once
bleeding has stopped and
assess for any signs of
infection at the site, such as
redness, swelling, warmth,
tenderness, or purulent
drainage.
 Tape the gauze or apply a
Band-Aid over the IV site.
 Record any Relevant Findings

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 Time/ Side-
Doctor’s Order Rationale Nursing Responsibilities*
Notes
Status: Post
 The uterus must be well  Perform Tamponade
Normal
contracted after birth to Techniques
Spontaneous Keep Uterus Well
prevent excessive bleeding  Massage Uterus to allow the
Delivery with Contracted
and promote efficient passage of blood clots
Perineal
Support
postpartum healing  Encourage the Patient to rest
 Educate and encourage patient
on Proper Post-Partum Hygiene
Daily Perineal
which includes cleansing
Hygiene, wash  To avoid perineal infection
techniques with Betadine
with Betadine
Solution, Frequent Sanitary Pad
changing, and baths.
 Identify the Patient
 Double-check the order and
drug packaging
 Prepare Medications
 Educate the Client regarding the
Oxytocin 1 amp,  Contracts the uterus to avoid
IM NOW drug and their rights
excessive bleeding
 Administer the Medication
 Monitor Patient’s Progress.
Note for Adverse Effects such
as confusion, drowsiness,
headache, or seizures
Medications
Cefuroxime
500mg per 1 tab, 1  To Avoid Infection
tab BID
 Identify the Patient
Mefenamic Acid
 To treat mild to moderate  Double-check the order and
Capsule, 1 cap
pain drug packaging
TID
 Prepare Medications
 Ferrous Sulfate is a common
 Educate the Client regarding the
treatment for iron deficiency
Ferrous Sulfate + drug and their rights
anemia in the postpartum
Folic Acid tab, 1  Administer the Medication
period
tab BID  Monitor Patient’s Progress.
 Folic Acid is also used to
treat Anemia Note for Adverse Effects
Ascorbic Acid tab,  To boost mother’s immunity
1 tab OD after childbirth
 Allows patients to gradually  Inform the Patient regarding
resume eating based on their order
comfort levels and  Though the Patient is permitted
May have Diet as
gastrointestinal function, to have her typical diet,
Tolerated
promoting optimal recovery Education on healthy eating
and reducing the risk of habits and meal planning is still
complications a must.
 Refer accordingly and report
Refer  For Continuous Monitoring
any concerns

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Time/ Side-
Doctor’s Order Rationale Nursing Responsibilities*
Notes
April 14, 2024;
 To deliver the patient’s
progress and to be informed  Refer accordingly and report
9:30 AM Refer to Dr. S.S
of any changes to the any concerns
patient’s care plan
 To promote family planning
 Counsel the Patient on the
For Post Partum and allow the mother to
Procedure and its purpose
Bilateral Tubal prioritize her recovery and
 Allow the Patient to
Ligation well-being after childbirth
contemplate
(Mayo Clinic, 2023)
 To establish Legal
Foundation by protecting
 Serve as witness
Patient’s Rights and deviating
 Inform Patient of their rights
Secure Consent the institution from legal
repercussions.  Explain the purpose of the
Consent
 For Documentation and
Record keeping
For
 To ensure the Patient doesn’t
Cardiopulmonary  Inform and Educate the Patient
have any cardiopulmonary
clearance prior to regarding the procedure
conditions
the procedure
Diagnostics
 To assess for potential  Confirm the Patient’s Identity
pulmonary complications  Explain the Procedure to the
Chest X-Ray following surgery, such as Patient
Posterior-Anterior/ atelectasis or pneumonia,  Secure Consent
Lateral especially in patients with  Assist the Patient in the
underlying conditions (CDC, procedure if necessary and
2017). permitted
 To monitor cardiac function  Facilitate Lab Request
and identify any  Refer Relevant Findings
abnormalities, which is
12 LECG crucial for patients with
hyperthyroidism due to
potential cardiovascular
complications (AHA, 2014).
 To evaluate thyroid hormone
levels and ensure appropriate
Thyroid Function management of
Test (TSH, T-T3, hyperthyroidism, as it can
T-T4) affect postoperative recovery
and overall health (Endocrine
Society, 2016).
Blood Urea and  To assess renal function and
Nitrogen, identify any impairment,
Creatinine especially in patients with
hyperthyroidism who may be
at increased risk of kidney

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Time/ Side-
Doctor’s Order Rationale Nursing Responsibilities*
Notes
dysfunction (NKF, 2020).
 To monitor electrolyte
balance, as hyperthyroidism
can lead to electrolyte
Sodium,
imbalances, which may affect
Potassium
postoperative recovery and
cardiovascular health
(Endocrine Society, 2016).
 To evaluate liver function and
detect any abnormalities,
particularly important in
AST/ALT
patients with hyperthyroidism
due to potential hepatic
involvement (AACE, 2016).
 To screen for diabetes or
impaired glucose tolerance,
Fasting Blood as hyperthyroidism can affect
Sugar Test glucose metabolism and
increase the risk of
hyperglycemia (ADA, 2021).
 For continuous monitoring  Refer accordingly and report
Refer
any concerns
The patient
April 15,
refused to undergo
2024; 8:45  
Bilateral Tubal
AM
Ligation
*The subsequent nursing responsibilities were derived from verified online sources, specifically Nurse's
Lab and Nursing Together; and from textbooks such as Kozier and Erb’s Fundamentals of Nursing

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